山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (4): 60-65.doi: 10.6040/j.issn.1673-3770.0.2018.267

• 论著 • 上一篇    下一篇

粉尘螨滴剂舌下含服免疫治疗对不同年龄段变应性鼻炎患者的临床效果评估

张贵阳,黄河,冼志,张汉文,谢桂彩   

  1. 东莞市第三人民医院耳鼻喉科, 广东 东莞 523326
  • 出版日期:2019-07-20 发布日期:2019-07-22
  • 基金资助:
    东莞市科技局课题(2016105101041)

Evaluation of clinical effects of sublingual immunotherapy with Dermatophagoides farinae drops in patients of different age groups with allergic rhinitis

ZHANG Guiyang, HUANG He, XIAN Zhi, ZHANG Hanwen, XIE Guicai   

  1. Department of Otolaryngology, Dongguan Third People′s Hospital, Dongguan 523326, Guangdong, China
  • Online:2019-07-20 Published:2019-07-22

PDF (PC)

177

摘要： 目的 探究粉尘螨滴剂舌下含服免疫治疗对不同年龄段变应性鼻炎(AR)患者的临床效果。 方法 将2016年3月~8月收治的240例AR患者根据年龄分为6组,学龄前组为3~6岁,学龄期组为7~12岁,青春期组为13~20岁,青年期组为21~40岁,中年期组为41~60岁,老年期组为60岁以上,每组40例。均采用舌下含服粉尘螨滴剂变应原特异性免疫治疗+药物治疗,其中粉尘螨滴剂的脱敏治疗分为递增及维持剂量2个阶段。脱敏治疗同时根据患者情况联合控制症状药物治疗。6个月后比较各组症状评分、药物评分、体征评分及视觉模拟量表(VAS)评分,并统计各组有效率及不良事件发生率。 结果 治疗6个月后各组症状评分、药物评分、体征评分及VAS评分均有显著改善,学龄前组、学龄期组、青春期组、青年期组、中年期组、老年期症状评分分别为(3.20±0.79)、(3.58±0.81)、(3.92±0.70)、(4.25±0.72)、(4.59±0.75)、(4.96±0.80)分,药物评分分别为(0.84±0.32)、(0.98±0.30)、(1.14±0.41)、(1.33±0.44)、(1.52±0.40)、(1.72±0.48)分,体征评分分别为(0.18±0.02)、(0.21±0.05)、(0.24±0.06)、(0.27±0.07)、(0.31±0.06)、(0.35±0.07)分,VAS评分分别为(1.82±0.39)、(2.08±0.51)、(2.31±0.50)、(2.54±0.53)、(2.78±0.52)、(3.00±0.46)分,年龄越低的组,各项评分改善效果越显著,差异均有统计学意义(F分别为28.111、28.111、48.241、32.607,P均<0.001);学龄前组、学龄期组、青春期组、青年期组、中年期组、老年期组治疗有效率分别为95.00%、95.00%、90.00%、87.50%、87.50%、82.50%,各组比较差异无统计学意义(χ2=20.293,P=0.161);青年期组、中年期组及老年期组不良事件发生率(30.00%、25.00%、25.00%)低于学龄前组、学龄期组及青春期组(7.50%、5.00%、7.50%),差异均有统计学意义(χ2分别为6.646、4.501、4.501,8.658、6.275、6.275,6.646、4.501、4.501,P分别为0.010、0.034、0.034,0.003、0.012、0.012,0.010、0.034、0.034)。 结论 AR患者应用粉尘螨滴剂舌下含服免疫治疗效果均较好,且随患者年龄增长,效价相对降低,安全性相对升高。

关键词: 变应性鼻炎, 免疫治疗, 粉尘螨滴剂, 年龄, 治疗结局

Abstract: ObjectiveTo explore the clinical effects of sublingual immunotherapy with Dermatophagoides farinae drops in patients of different age groups with allergic rhinitis(AR). Methods A total of 240 patients with AR admitted to the hospital from March to August 2016 were divided into six groups based on their age(3-6 years old, preschool group; 7-12 years old, school group; 13-20 years old, puberty group; 21-40 years old, adolescent group; 41-60 years old, middle-age group; older than 60 years, old-age group), with 40 patients in each group. The patients were treated with sublingual administration of Dermatophagoides farinae drops. The desensitization therapy of Dermatophagoides farinae drops included two stages: increasing dose and maintenance dose. The desensitization therapy was combined with symptomatic drug treatment based on the patient's condition. Scores of symptoms, drugs, physical signs, and visual analog scale(VAS)were compared between the two groups after 6 months. The effective and incidence rates of adverse events were statistically analyzed in each group. Results After 6 months of treatment, the scores of symptoms(3.20±0.79, 3.58±0.81, 3.92±0.70, 4.25±0.72, 4.59±0.75, and 4.96±0.80 points), drugs(0.84±0.32, 0.98±0.30, 1.14±0.41, 1.33±0.44, 1.52±0.40, and 1.72±0.48 points), physical signs(0.18±0.02, 0.21±0.05, 0.24±0.06, 0.27±0.07, 0.31±0.06, and 0.35±0.07 points), and VAS(1.82±0.39, 2.08±0.51, 2.31±0.50, 2.54±0.53, 2.78±0.52, and 3.00±0.46 points)significantly improved in the preschool, school, puberty, adolescent, middle-age, and old-age groups. The lower the age of the patient, more obvious were effects of score improvement(F=28.111, 28.111, 48.241, 32.607; P<0.001). The effective rates of efficacy in the preschool, school, puberty, adolescent, middle-age, and old-age groups were 95.00%, 95.00%, 90.00%, 87.50%, 87.50%, and 82.50%, respectively(χ2=20.293, P=0.161). The incidence rates of adverse events in the adolescent, middle-age, and old-age groups(30.00%, 25.00%, and 25.00%, respectively)were lower than those in the preschool, school, and puberty groups(7.50%, 5.00%, and 7.50%, respectively)(χ2=6.646, 4.501, 4.501, 8.658, 6.275, 6.275, 6.646, 4.501, 4.501; P=0.010, 0.034, 0.034, 0.003, 0.012, 0.012, 0.010, 0.034, 0.034). Conclusion Sublingual immunotherapy with Dermatophagoides farinae drops is effective in treating patients with AR. The titer lowers with age, while the safety increases.

Key words: Allergic rhinitis, Immunotherapy, Dermatophagoides farinae drops, Age, Treatment outcome

中图分类号: 

  • R765.21
[1] 梁美君, 徐睿, 许庚. 变应性鼻炎研究新进展[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(3): 202-206. doi:10.13201/j.issn.1001-1781.2015.03.003. LIANG Meijun, XU Rui, XU Geng. Recent advances in allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(3): 202-206. doi:10.13201/j.issn.1001-1781.2015.03.003.
[2] 李华斌. 变应性鼻炎的发病机制及诊治进展[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(4): 347-352. doi:10.3760/cma.j.issn.1673-0860.2014.04.019.
[3] 王玉芬. 特异性免疫治疗对变应性鼻炎近期疗效和安全性的临床研究[J]. 中国医药导报, 2013, 10(18): 152-153,157. doi:10.3969/j.issn.1673-7210.2013.18.05. WANG Yufen. Specific immune therapy on short-term effect of allergic rhinitis[J]. China Medical Herald, 2013, 10(18): 152-153,157. doi:10.3969/j.issn.1673-7210.2013.18.054.
[4] 丁俊杰, 张建华, 陈斌. 变应性鼻炎患者特异性免疫治疗后的疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2014(5): 293-296. DING Junjie, ZHANG Jianhua, CHEN Bin. The analysis of the efficacy of patients with allergic rhinitis treated with specific immunotherapy[J]. Journal of Clinical Otorhinolaryngology, 2014(5): 293-296.
[5] 宋薇薇, 林小平, 柴若楠. 标准化屋尘螨变应原特异性免疫治疗变应性鼻炎的疗效评估[J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(5): 300-302. doi:10.13201/j.issn.1001-1781.2014.05.006. SONG Weiwei, LIN Xiaoping, CHAI Ruonan. Efficacy evaluation of standardized dust mite allergen specific immunotherapy to patients of allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2014, 28(5): 300-302. doi:10.13201/j.issn.1001-1781.2014.05.006.
[6] 程雷. 变应性鼻炎特异性舌下免疫治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2015(3): 197-199. CHENG Lei. Sublingual specific immunotherapy for allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology, 2015(3): 197-199.
[7] 中华耳鼻咽喉头颈外科杂志编委会.变应性鼻炎诊断和治疗指南[J].中国临床医生杂志,2010,38(6):67-68.
[8] Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma(ARIA)2008[J]. Allergy, 2008,63(s86):8-160.
[9] Canonica GW, Cox L, Pawankar R, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update[J]. World Allergy Organization Journal, 2014, 7: 6. doi:10.1186/1939-4551-7-6.
[10] 葛荣明, 余少卿. 变应性鼻炎的舌下特异性免疫治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(9): 777-780. doi:10.13201/j.issn.1001-1781.2015.09.002. GE Rongming, YU Shaoqing. Sublingual immunotherapy of allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(9): 777-780. doi:10.13201/j.issn.1001-1781.2015.09.002.
[11] 李胜兰, 陶泽璋. 变应原特异性免疫治疗变应性鼻炎的药物经济学[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(4): 347-349. doi:10.3760/cma.j.issn.1673-0860.2015.04.022.
[12] 尤少华, 秦晓燕, 徐丛, 等. 舌下含服和皮下注射特异性免疫治疗变应性鼻炎的疗效研究[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(9): 689-693. doi:10.13201/j.issn.1001-1781.2016.09.005. YOU Shaohua, QIN Xiaoyan, XU Cong, et al. Comparison study of subcutaneous immunotherapy and sublingual immunotherapy in patients with allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(9): 689-693. doi:10.13201/j.issn.1001-1781.2016.09.005.
[13] 翁永彩, 顾东胜, 曾冬前, 等. 变应性鼻炎患者舌下变应原特异性免疫治疗的依从性及有效性分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(7): 542-545. doi:10.13201/j.issn.1001-1781.2016.07.009. WENG Yongcai, GU Dongsheng, ZENG Dongqian, et al. Analysis of the compliance and effectiveness of the allergen specific immunotherapy in patients with allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(7): 542-545. doi:10.13201/j.issn.1001-1781.2016.07.009.
[14] 黄正华, 周艾. 舌下特异性免疫治疗儿童变应性鼻炎长期疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(14): 1011-1014. doi:10.13201/j.issn.1001-1781.2014.14.001. HUANG Zhenghua, ZHOU Ai. Long-term clinical efficacy of sublingual immunotherapy in children with allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2014, 28(14): 1011-1014. doi:10.13201/j.issn.1001-1781.2014.14.001.
[15] 李朋, 法明, 黄正华, 等. 舌下特异性免疫治疗在儿童变应性鼻炎中的疗效[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(7): 546-551. doi:10.13201/j.issn.1001-1781.2016.07.010. LI Peng, FA Ming, HUANG Zhenghua, et al. The efficacy of sublingual specific immunotherapy in children with allergic rhinitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(7): 546-551. doi:10.13201/j.issn.1001-1781.2016.07.010.
[1] 刘鸣. 早期声门癌的内镜治疗[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 6-9.
[2] 申宇鹏,宋琦,李晓明. 喉癌前病变的病因、分子机制和处理策略[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 25-30.
[3] 钟晓声,杨海弟,郑亿庆. 突发性聋伴耳鸣的治疗与转归[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 43-46.
[4] 罗通勇,杨华清,岳胜清,贾全凡,袁龙. 帕尼单抗和紫杉醇一线治疗复发或转移性头颈肿瘤Ⅱ期患者效果观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 71-75.
[5] 刘燕,魏萍,寇巍,胡思洁,武小芳,刘萌雅,陈成,姚红兵. 儿童腺样体肥大与耳鼻咽喉科常见疾病关系的研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 149-154.
[6] 郎永耀,杨云,刘晴,徐林弟,林子萍. 咽喉反流性疾病的影响因素及治疗效果分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 119-123.
[7] 钱俊俊,周文成,吴中飞,卜冬云,汪李琴,陆美萍,程雷. 苏皖地区变应性鼻炎患者吸入性变应原谱分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 147-151.
[8] 王登元,陈智斌,王杪琳. 伴发梅尼埃病的良性阵发性位置性眩晕的临床特点[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 61-65.
[9] 田慧琴,吴中飞,陆莹,程雷. GC和CYP27B1基因多态性与汉族人群尘螨致敏的持续性变应性鼻炎的关联研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 71-78.
[10] 陈若希,张清照,陆美萍,朱歆洁,程雷. TLR通路基因多态性与变应性鼻炎的关联研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 79-87.
[11] 王登元, 陈智斌, 邢光前. 耳内镜微创术——耳科手术的新途径[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 27-30.
[12] 陆美萍,程雷. 变应性鼻炎的遗传学研究现状[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 36-41.
[13] 郭胤仕,卢慧. Ⅱ型固有淋巴细胞在变应性鼻炎发病机制中的作用[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 9-12.
[14] 关凯,王良录. 从花粉症看过敏性疾病的整体诊疗策略[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 13-19.
[15] 郝创利,顾文婧. 认识不同年龄儿童慢性咳嗽的病因[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 20-24.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 邓基波,孙奉乾,许安廷 . 大前庭导水管综合征[J]. 山东大学耳鼻喉眼学报, 2006, 20(2): 116 -118 .
[2] 周斌,李滨 . 鼻内窥镜下鼻窦鼻息肉手术75例疗效观察[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 24 -26 .
[3] 徐赛男,杨雷 . 红霉素促进鼻息肉上皮细胞凋亡的实验研究[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 27 -29 .
[4] 谢治年 综述,姬长友 审校 . RNA干扰及其在喉鳞癌研究中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 200 -203 .
[5] 乔 艺,倪关森,陈文文 . 改良悬雍垂腭咽成形术联合鼻腔手术治疗阻塞性睡眠呼吸暂停综合征38例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 206 -208 .
[6] 汪晓锋,林 昶,程金妹 . 不同龄小鼠内耳中ABAD的表达及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 207 -211 .
[7] 杨淑娟,袁 英,刘付星,秦海平 . 美宝湿润烧伤膏联合蛋膜贴补治疗外伤性鼓膜穿孔40例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 227 -227 .
[8] 林峰,梁勇,卢永田,万丽霞 . 鼻内翻性乳头状瘤临床分型和术式选择[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 231 -233 .
[9] 王宗峰,张志莉,李建东,李剑弋 . 控制性降压对鼻内镜手术视野及脑血流变化的影响[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 239 -241 .
[10] 白广平,李 俊,董 频 . 鼻内镜下手术治疗慢性鼻窦炎、鼻息肉180例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 242 -243 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发